Commentary from the Object Relations Point of View

The case of Mr L demonstrates the value of an object relations perspective on the psychoanalytic process. Dr Horowitz points out at the outset that what ‘stands out’ for him is conducting an analysis with ‘someone who deeply wanted to have one [an analysis] but almost as deeply could not bring himself to have one’. The question for the analyst is: why, given that he wanted an analysis to improve his career and severely restricted social life, did he have such difficulty ‘bringing himself to have one’? His initial analytic dream displayed his fear that the analyst was an ‘ugly hooker’ who would ‘tear his insides out’. Mr L could see even at this early point that beginning analysis led to feelings of ‘exposure, abuse, desire to make myself more shameful’. What will be exposed? The recounting of his history makes clear that he has borne a painful sense of inadequacy all his life. He suffered ridicule from the family members who raised him in addition to the excruciating shame of numerous episodes of waiting for his father who did not appear. He was humiliated for being a ‘sissy’ as well as for being male. Also important to Mr L's shame is the fact that the whole family is shame-prone. The parents treated their divorce as a defect that must be hidden. The charade that the parents were still married for years after their divorce reflects the inability of the family to accept the reality of their lives and display a realistic sense of themselves to others. Mr L lives in continual fear that his ‘defect’ will be exposed to others. Should they see how defective he is, their cruelty is akin to ‘tearing his innards’ out.

The anxiety of others seeing his defect is at the root of his paranoia. When Mr L says he is given to ‘nasty projections’, he is referring to his experience of others when he feels they ‘see inside’ him. When Mr L is not perfectly understood, he feels exposed, and this feeling of exposure accounts for the intensity of his reaction. Mr L's pained response to an